433:
frequently accompanied by Q-waves, T-wave inversions (while ST is still elevated unlike pericarditis), arrhythmias and conduction abnormalities. In AMI, PR-depressions are rarely present. Early repolarization usually occurs in young males (age <40 years) and ECG changes are characterized by terminal R-S slurring, temporal stability of ST-deviations and J-height/ T-amplitude ratio in V5 and V6 of <25% as opposed to pericarditis where terminal R-S slurring is very uncommon and J-height/ T-amplitude ratio is ≥ 25%. Very rarely, ECG changes in hypothermia may mimic pericarditis, however differentiation can be helpful by a detailed history and presence of an
Osborne wave in hypothermia.
563:, which has been essential to treat recurrent pericarditis, has been supported for routine use in acute pericarditis by recent prospective studies. Colchicine can be given 0.6 mg twice a day (0.6 mg daily for patients <70 kg) for 3 months following an acute attack. It should be considered in all patients with acute pericarditis, preferably in combination with a short-course of NSAIDs. For patients with a first episode of acute idiopathic or viral pericarditis, they should be treated with an NSAID plus colchicine 1–2 mg on first day followed by 0.5 daily or twice daily for three months. It should be avoided or used with caution in patients with severe
53:
338:
29:
91:
183:
437:
pericarditis. The sign is often best visualized in lead II and lateral precordial leads. In addition, Spodick's sign may also serve as an important distinguishing electrocardiographic tool between the acute pericarditis and acute coronary syndrome. The presence of a classical
Spodick's sign is often a giveaway to the diagnosis.
546:
pericarditis. In patients with underlying causes other than viral, the specific etiology should be treated. With idiopathic or viral pericarditis, NSAID is the mainstay treatment. Goal of therapy is to reduce pain and inflammation. The course of the disease may not be affected. The preferred NSAID is
432:
The two most common clinical conditions where ECG findings may mimic pericarditis are acute myocardial infarction (AMI) and generalized early repolarization. As opposed to pericarditis, AMI usually causes localized convex ST-elevation usually associated with reciprocal ST-depression which may also be
556:
800 mg every 6–8 hours. Dose tapering of NSAIDs may be needed. In pericarditis following acute myocardial infarction, NSAIDs other than aspirin should be avoided since they can impair scar formation. As with all NSAID use, GI protection should be engaged. Failure to respond to NSAIDs within one
474:
Patients with uncomplicated acute pericarditis can generally be treated and followed up in an outpatient clinic. However, those with high risk factors for developing complications (see above) will need to be admitted to an inpatient service, most likely an ICU setting. High risk patients include the
436:
Another important diagnostic electrocardiographic sign in acute pericarditis is the
Spodick sign. It signifies to the PR-depressions in a usual (but not always) association with downsloping TP segment in patients with acute pericarditis and is present in up to 80% of the patients affected with acute
403:(the layer directly surrounding the heart), since the fibrous pericardium is electrically inert. For example, in uremia, there is no inflammation in the epicardium, only fibrin deposition, and therefore the EKG in uremic pericarditis will be normal. Typical EKG changes in acute pericarditis includes
226:
is a very specific sign of acute pericarditis, meaning the presence of this sign invariably indicates presence of disease. However, absence of this sign does not rule out disease. This rub can be best heard by the diaphragm of the stethoscope at the left sternal border arising as a squeaky or
609:. Recent studies have shown this to be an uncommon complication. The definitive treatment for constrictive pericarditis is pericardial stripping, which is a surgical procedure where the entire pericardium is peeled away from the heart.
345:
For acute pericarditis to formally be diagnosed, two or more of the following criteria must be present: chest pain consistent with a diagnosis of acute pericarditis (sharp chest pain worsened by breathing in or a cough), a
551:
because of rare side effects, better effect on coronary flow, and larger dose range. Depending on severity, dosing is between 300 and 800 mg every 6–8 hours for days or weeks as needed. An alternative protocol is
1579:
1564:
573:
are usually used in those cases that are clearly refractory to NSAIDs and colchicine and a specific cause has not been found. Systemic corticosteroids are usually reserved for those with autoimmune disease.
1137:
Imazio M, Demichelis B, Parrini I, Giuggia M, Cecchi E, Gaschino G, Demarie D, Ghisio A, Trinchero R (2004). "Day-hospital treatment of acute pericarditis: a management program for outpatient therapy".
1178:"Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European Society of Cardiology"
557:
week (indicated by persistence of fever, worsening of condition, new pericardial effusion, or continuing chest pain) likely indicates that a cause other than viral or idiopathic is in process.
231:, which is similar but sounds more like a "swish" sound than a scratching sound. The pericardial rub is said to be generated from the friction generated by the two inflamed layers of the
907:
Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; Peter
Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L'Italien; David Manthey (2007).
1357:
Adler Y, Zandman-Goddard G, Ravid M, Avidan B, Zemer D, Ehrenfeld M, Shemesh J, Tomer Y, Shoenfeld Y (1994). "Usefulness of colchicine in preventing recurrences of pericarditis".
466:
is typically normal in acute pericarditis but can reveal pericardial effusion, the presence of which supports the diagnosis, although its absence does not exclude the diagnosis.
590:--- to cause serious obstruction to the inflow of blood to the heart. Signs of cardiac tamponade include distended neck veins, muffled heart sounds when listening with a
1005:
Chhabra, Lovely; Spodick, David H. (2012). "Ideal
Isoelectric Reference Segment in Pericarditis: A Suggested Approach to a Commonly Prevailing Clinical Misconception".
203:
surface at the same time. The pain may be reduced with sitting up and leaning forward while worsened with lying down, and also may radiate to the back, to one or both
982:
Chhabra L, Spodick DH. Pericardial disease in the elderly. In: Aronow WS, Fleg JL, Rich MW, (ed.). Tresch and Aronow's
Cardiovascular Disease in the Elderly. 5th ed
459:
is present and is greater than 200 mL in volume. Conversely, patients with unexplained new onset cardiomegaly should always be worked up for acute pericarditis.
2755:
2326:
239:
does not necessarily present a rub. The rub is best heard during the maximal movement of the heart within the pericardial sac, namely, during atrial
101:
605:
Another longer term complication of pericarditis, if it recurs over a longer period of time (normally more than 3 months), is progression to
415:
in aVR and V1. Elevation of PR segment in aVR and depression of PR in other leads especially left heart V5, V6 leads indicates atrial injury.
1392:
Imazio M, Bobbio M, Cecchi E, Demarie D, Demichelis B, Pomari F, Moratti M, Gaschino G, Giammaria M, Ghisio A, Belli R, Trinchero R (2005).
265:
but a viral cause is suspected in the majority of such cases. The other 10–20% of acute pericarditis cases have various causes including
521:
is a procedure whereby the fluid in a pericardial effusion is removed through a needle. It is performed under the following conditions:
1967:
1394:"Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial"
377:
I (cTnI), both of which are also markers for injury to the muscular layer of the heart. Therefore, it is imperative to also rule out
290:
227:
scratching sound, resembling the sound of leather rubbing against each other. This sound should be distinguished from the sound of a
195:
is one of the common symptoms of acute pericarditis. It is usually of sudden onset, occurring in the anterior chest and often has a
2750:
1657:
1435:"Colchicine as first-choice therapy for recurrent pericarditis: results of the CORE (COlchicine for REcurrent pericarditis) trial"
162:
1048:
Chhabra, Lovely; Spodick, David H. (2012). "Hypothermia masquerading as pericarditis: an unusual electrocardiographic analogy".
261:
There are several causes of acute pericarditis. In developed nations, the cause of most (80–90%) cases of acute pericarditis is
2384:
1701:
134:
916:
393:
in those patients should indicate normal vascular perfusion. Troponin levels increase in 35-50% of people with pericarditis.
2188:
2025:
141:
2379:
2193:
2183:
1772:
2490:
2321:
1935:
989:
2361:
1532:
148:
120:
2356:
2225:
2006:
36:
An ECG showing pericarditis. Note the ST elevation in multiple leads with slight reciprocal ST depression in aVR.
2740:
2301:
2296:
2220:
130:
2647:
2523:
2452:
2284:
2020:
1267:"Letter by Chhabra and Spodick Regarding Article, "Treatment of Acute and Recurrent Idiopathic Pericarditis""
1176:
Maisch B, Seferovic PM, Ristic AD, Erbel R, Rienmuller R, Adler Y, Tomkowski WZ, Thiene G, Yacoub MH (2004).
2745:
2642:
2435:
2418:
2351:
2271:
1650:
1050:
626:
599:
286:
270:
2485:
1930:
378:
208:
2467:
1955:
1940:
277:, or involve an inflammatory reaction of the pericardium following trauma to the heart such as after a
2014:
2545:
2242:
2210:
2137:
1864:
1433:
Imazio M, Bobbio M, Cecchi E, Demarie D, Pomari F, Moratti M, Ghisio A, Belli R, Trinchero R (2005).
606:
323:
266:
109:
77:) usually lasting less than 4 to 6 weeks. It is the most common condition affecting the pericardium.
1314:
Chhabra, Lovely (2015). "What we do not know about the role of colchicine in pericarditis in 2014".
293:
are rare inherited autoimmune diseases capable of causing recurring episodes of acute pericarditis.
52:
2669:
2495:
2425:
2215:
2112:
2093:
1923:
1696:
735:
Khandaker, MH; Espinosa, RE; Nishimura, RA; Sinak, LJ; Hayes, SN; Melduni, RM; Oh, JK (June 2010).
347:
223:
2702:
2676:
2664:
2652:
2637:
2371:
2313:
2117:
2098:
1750:
1690:
1643:
105:
1474:
Shabetai R (September 2005). "Recurrent pericarditis: recent advances and remaining questions".
155:
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1785:
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1860:
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822:
Bthere is a fondel onnefoy E, Godon P, Kirkorian G, Fatemi M, Chevalier P, Touboul P (2000).
278:
1087:"Spodick's Sign: A Helpful Electrocardiographic Clue to the Diagnosis of Acute Pericarditis"
116:
2551:
2079:
2060:
1960:
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824:"Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis"
761:
736:
717:
518:
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240:
216:
207:
ridges. However, the pain can also be dull and steady, resembling the chest pain in an
1487:
1410:
1393:
1283:
1266:
945:
2719:
2570:
2528:
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1238:
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1067:
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721:
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1278:
1230:
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1106:
1098:
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1034:
1014:
941:
879:
866:
Imazio M, Demichelis B, Cecchi E, Belli R, Ghisio A, Bobbio M, Trinchero R (2003).
835:
796:
756:
748:
701:
666:
528:
diagnostic purpose for suspected purulent, tuberculosis, or neoplastic pericarditis
381:
in the face of these biomarkers. The elevation of these substances may occur when
369:
may be elevated. Acute pericarditis is associated with a modest increase in serum
2714:
2106:
2087:
2074:
1881:
1760:
1635:
1522:
1451:
1434:
1327:
705:
586:. Cardiac tamponade is accumulation of enough fluid in the pericardial space ---
570:
370:
2707:
2615:
2513:
2505:
2403:
1913:
1906:
1893:
1151:
884:
867:
463:
199:
quality that worsens with breathing in or coughing, due to inflammation of the
1194:
1177:
821:
2734:
2697:
2608:
1743:
1292:
412:
408:
389:(see below) is more common in those patients with a cTnI > 1.5 ÎĽg/L.
1573:
800:
2629:
2603:
2447:
2395:
2068:
2044:
1991:
1850:
1495:
1460:
1419:
1335:
1300:
1242:
1203:
1159:
1120:
1071:
1026:
953:
893:
849:
840:
823:
808:
770:
734:
713:
678:
483:
452:
306:
228:
70:
66:
1378:
752:
670:
451:
is usually normal in acute pericarditis but can reveal the presence of an
2564:
2462:
2252:
2169:
2151:
1977:
1950:
1901:
1842:
1607:
1102:
692:
Imazio, M (May 2012). "Contemporary management of pericardial diseases".
595:
591:
399:(ECG) changes in acute pericarditis mainly indicates inflammation of the
382:
341:
ECG showing slight ST elevation in many leads congruent with pericarditis
312:
232:
74:
1556:
787:
Spodick DH (2003). "Acute pericarditis: current concepts and practice".
2592:
2142:
1234:
560:
400:
262:
211:. As with any chest pain, other causes must also be ruled out, such as
192:
119:
if you can. Unsourced or poorly sourced material may be challenged and
46:
1018:
657:
LeWinter MM (December 2014). "Clinical practice. Acute pericarditis".
1618:
548:
428:
stage 4 -- EKG becomes normal OR T waves may be indefinitely inverted
337:
204:
909:
Emergency medicine: avoiding the pitfalls and improving the outcomes
2518:
1675:
374:
301:
Clinical presentation of diseases of pericardium may vary between:
244:
196:
243:, ventricular systole, and the filling phase of early ventricular
28:
553:
2598:
2578:
1733:
1568:
1356:
535:
422:
274:
200:
1136:
582:
One of the most feared complications of acute pericarditis is
499:
448:
250:
865:
602:). This condition can be fatal if not immediately treated.
212:
1175:
1432:
1391:
932:
Troughton RW, Asher CR, Klein AL (2004). "Pericarditis".
386:
385:
in addition to acute pericarditis. Also, ST elevation on
911:. Malden, Mass: Blackwell Pub./BMJ Books. p. 10.
253:
may be present since this is an inflammatory process.
1546:
444:
may be seen, depending on the size of the effusion.
931:
514:
failure to respond to seven days of NSAID treatment
1665:
1265:Chhabra, Lovely; Spodick, David H. (2013-11-05).
2732:
525:presence of moderate or severe cardiac tamponade
418:stage 2 -- normalization of ST and PR deviations
984:. Boca Raton, FL: CRC Press. pp. 644–668.
737:"Pericardial disease: diagnosis and management"
498:(echo-free space > 20 mm) resistant to
425:inversions (may not be present in all patients)
1264:
1216:
1047:
1004:
652:
650:
648:
646:
644:
642:
640:
115:Please review the contents of the section and
1651:
365:may show an elevated white count and a serum
1467:
728:
685:
656:
637:
531:persistent symptomatic pericardial effusion
1968:Arrhythmogenic right ventricular dysplasia
1658:
1644:
1473:
1223:American Journal of Health-System Pharmacy
1171:
1169:
1132:
1130:
868:"Cardiac troponin I in acute pericarditis"
786:
383:inflammation of the heart's muscular layer
358:(ECG) consistent with acute pericarditis.
51:
27:
1450:
1409:
1282:
1193:
1110:
883:
839:
782:
780:
760:
291:TNF receptor associated periodic syndrome
2756:Herpes simplex virus–associated diseases
1524:Textbook of Clinical Electrocardiography
925:
861:
859:
336:
1426:
1385:
1313:
1166:
1127:
1084:
979:
815:
508:history of oral anticoagulation therapy
2733:
1702:Spontaneous coronary artery dissection
777:
691:
73:of the sac surrounding the heart, the
1639:
1520:
1350:
1260:
1258:
975:
973:
971:
856:
80:
2026:Nonbacterial thrombotic endocarditis
1217:Chhabra, L.; Spodick, D. H. (2014).
84:
482:high fever (> 100.4 F/38 C) and
311:Pericardial effusion without major
13:
2322:Accelerated idioventricular rhythm
1514:
1316:Journal of Cardiovascular Medicine
1255:
1064:10.1016/j.jelectrocard.2012.03.006
968:
328:Effusive-constrictive pericarditis
296:
14:
2767:
1542:
1488:10.1161/circulationaha.105.569244
1411:10.1161/CIRCULATIONAHA.105.542738
1284:10.1161/CIRCULATIONAHA.113.003737
181:
89:
2751:Enterovirus-associated diseases
2007:Subacute bacterial endocarditis
1307:
1210:
1078:
1041:
998:
659:New England Journal of Medicine
1527:. Jaypee Brothers Publishers.
900:
619:
407:stage 1 -- diffuse, positive,
117:add the appropriate references
1:
2524:Pulseless electrical activity
2453:Multifocal atrial tachycardia
2327:Catecholaminergic polymorphic
946:10.1016/S0140-6736(04)15648-1
694:Current Opinion in Cardiology
612:
1452:10.1001/archinte.165.17.1987
1371:10.1016/0002-9149(94)90828-1
1328:10.2459/jcm.0000000000000225
1051:Journal of Electrocardiology
706:10.1097/HCO.0b013e3283524fbe
577:
469:
332:
287:Familial mediterranean fever
271:systemic lupus erythematosus
7:
1521:Chugh, S. N. (2014-05-14).
379:acute myocardial infarction
209:acute myocardial infarction
102:reliable medical references
10:
2772:
2468:Wandering atrial pacemaker
2015:non-infective endocarditis
1956:Endocardial fibroelastosis
1152:10.1016/j.jacc.2003.09.055
885:10.1016/j.jacc.2003.02.001
631:American Heart Association
267:connective tissue diseases
2685:
2628:
2546:hexaxial reference system
2537:
2504:
2491:Jervell and Lange-Nielsen
2476:
2434:
2393:
2370:
2344:
2312:
2270:
2251:
2150:
2136:
2036:
2021:Libman–Sacks endocarditis
1990:
1976:
1892:
1841:
1834:
1771:
1726:
1683:
1674:
1598:
1550:
1195:10.1016/j.ehj.2004.02.002
607:constrictive pericarditis
324:Constrictive pericarditis
256:
108:or relies too heavily on
40:
35:
26:
21:
2426:Ventricular fibrillation
1697:Coronary artery aneurysm
980:Chhabra, Lovely (2014).
373:MB (CK-MB). and cardiac
348:pericardial friction rub
235:; however, even a large
224:pericardial friction rub
2703:Diastolic heart failure
2677:Athletic heart syndrome
2638:Ventricular hypertrophy
2372:Pre-excitation syndrome
2226:Left posterior fascicle
1751:Acute coronary syndrome
1691:Coronary artery disease
1085:Chaubey, Vinod (2014).
801:10.1001/jama.289.9.1150
741:Mayo Clinic Proceedings
627:"What Is Pericarditis?"
2221:Left anterior fascicle
2001:infective endocarditis
1786:Hibernating myocardium
1667:Cardiovascular disease
1091:The Permanente Journal
841:10.1053/euhj.1999.1907
565:chronic kidney disease
342:
219:, muscular pain, etc.
2741:Pericardial disorders
2385:Wolff–Parkinson–White
2345:Premature contraction
2243:Adams–Stokes syndrome
1946:Loeffler endocarditis
1756:Myocardial infarction
753:10.4065/mcp.2010.0046
671:10.1056/NEJMcp1404070
340:
2552:Right axis deviation
2514:Sudden cardiac death
1872:Pericardial effusion
1815:Ventricular aneurysm
588:pericardial effusion
496:pericardial effusion
457:pericardial effusion
442:electrical alternans
391:Coronary angiography
363:complete blood count
352:pericardial effusion
305:Acute and recurrent
237:pericardial effusion
131:"Acute pericarditis"
2746:Medical terminology
2557:Left axis deviation
2414:Atrial fibrillation
2409:Ventricular flutter
2332:Torsades de pointes
2206:Bundle branch block
2165:Sick sinus syndrome
1951:Cardiac amyloidosis
1936:Tachycardia-induced
1791:Myocardial stunning
1739:Prinzmetal's angina
1708:Coronary thrombosis
598:(together known as
421:stage 3 -- diffuse
283:Dressler's syndrome
2660:Atrial enlargement
2458:Pacemaker syndrome
2380:Lown–Ganong–Levine
2302:Junctional ectopic
2297:AV nodal reentrant
1803:Myocardial rupture
1713:Coronary vasospasm
1599:External resources
1235:10.2146/ajhp140505
1103:10.7812/tpp/14-001
596:low blood pressure
519:Pericardiocentesis
367:C-reactive protein
343:
217:pulmonary embolism
81:Signs and symptoms
63:Acute pericarditis
22:Acute pericarditis
2728:
2727:
2720:Obstructive shock
2624:
2623:
2571:Short QT syndrome
2538:Other / ungrouped
2529:Sinoatrial arrest
2444:Ectopic pacemaker
2340:
2339:
2160:Sinus bradycardia
2132:
2131:
2128:
2127:
1877:Cardiac tamponade
1830:
1829:
1820:Dressler syndrome
1718:Myocardial bridge
1633:
1632:
1140:J Am Coll Cardiol
1019:10.1159/000339758
918:978-1-4051-4166-6
872:J Am Coll Cardiol
584:cardiac tamponade
505:immunocompromised
490:cardiac tamponade
397:Electrocardiogram
356:electrocardiogram
354:, and changes on
319:Cardiac tamponade
190:
189:
166:
60:
59:
16:Medical condition
2763:
2693:Cardiac fibrosis
2585:T wave alternans
2478:Long QT syndrome
2272:Supraventricular
2268:
2267:
2201:Intraventricular
2148:
2147:
1988:
1987:
1839:
1838:
1684:Coronary disease
1681:
1680:
1660:
1653:
1646:
1637:
1636:
1548:
1547:
1538:
1508:
1507:
1471:
1465:
1464:
1454:
1430:
1424:
1423:
1413:
1389:
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1382:
1354:
1348:
1347:
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1304:
1286:
1262:
1253:
1252:
1250:
1249:
1214:
1208:
1207:
1197:
1173:
1164:
1163:
1134:
1125:
1124:
1114:
1082:
1076:
1075:
1045:
1039:
1038:
1002:
996:
995:
977:
966:
965:
940:(9410): 717–27.
929:
923:
922:
904:
898:
897:
887:
863:
854:
853:
843:
819:
813:
812:
784:
775:
774:
764:
732:
726:
725:
689:
683:
682:
654:
635:
634:
623:
411:with reciprocal
185:
184:
176:
173:
167:
165:
124:
93:
92:
85:
56:
55:
31:
19:
18:
2771:
2770:
2766:
2765:
2764:
2762:
2761:
2760:
2731:
2730:
2729:
2724:
2715:Rheumatic fever
2681:
2620:
2533:
2500:
2472:
2430:
2389:
2366:
2336:
2308:
2255:
2247:
2141:
2124:
2032:
1981:
1972:
1888:
1882:Hemopericardium
1826:
1767:
1761:Unstable angina
1734:Angina pectoris
1727:Active ischemia
1722:
1670:
1664:
1634:
1629:
1628:
1594:
1593:
1559:
1545:
1535:
1517:
1515:Further reading
1512:
1511:
1472:
1468:
1445:(17): 1987–91.
1439:Arch Intern Med
1431:
1427:
1390:
1386:
1355:
1351:
1312:
1308:
1263:
1256:
1247:
1245:
1215:
1211:
1174:
1167:
1135:
1128:
1083:
1079:
1046:
1042:
1003:
999:
992:
978:
969:
930:
926:
919:
905:
901:
864:
857:
820:
816:
785:
778:
733:
729:
690:
686:
655:
638:
625:
624:
620:
615:
580:
571:Corticosteroids
488:development of
472:
371:creatine kinase
335:
299:
297:Pathophysiology
259:
186:
182:
177:
171:
168:
125:
114:
110:primary sources
94:
90:
83:
50:
17:
12:
11:
5:
2769:
2759:
2758:
2753:
2748:
2743:
2726:
2725:
2723:
2722:
2717:
2712:
2711:
2710:
2708:Cardiac asthma
2705:
2695:
2689:
2687:
2683:
2682:
2680:
2679:
2674:
2673:
2672:
2667:
2657:
2656:
2655:
2650:
2645:
2634:
2632:
2626:
2625:
2622:
2621:
2619:
2618:
2616:Strain pattern
2613:
2612:
2611:
2606:
2601:
2589:
2588:
2587:
2575:
2574:
2573:
2561:
2560:
2559:
2554:
2541:
2539:
2535:
2534:
2532:
2531:
2526:
2521:
2516:
2510:
2508:
2506:Cardiac arrest
2502:
2501:
2499:
2498:
2493:
2488:
2486:Andersen–Tawil
2482:
2480:
2474:
2473:
2471:
2470:
2465:
2460:
2455:
2450:
2440:
2438:
2432:
2431:
2429:
2428:
2423:
2422:
2421:
2411:
2406:
2404:Atrial flutter
2400:
2398:
2391:
2390:
2388:
2387:
2382:
2376:
2374:
2368:
2367:
2365:
2364:
2359:
2354:
2348:
2346:
2342:
2341:
2338:
2337:
2335:
2334:
2329:
2324:
2318:
2316:
2310:
2309:
2307:
2306:
2305:
2304:
2299:
2289:
2288:
2287:
2276:
2274:
2265:
2249:
2248:
2246:
2245:
2240:
2239:
2238:
2233:
2228:
2223:
2218:
2213:
2203:
2198:
2197:
2196:
2191:
2186:
2176:
2167:
2162:
2156:
2154:
2145:
2134:
2133:
2130:
2129:
2126:
2125:
2123:
2122:
2121:
2120:
2115:
2103:
2102:
2101:
2096:
2084:
2083:
2082:
2077:
2065:
2064:
2063:
2058:
2053:
2040:
2038:
2034:
2033:
2031:
2030:
2029:
2028:
2023:
2011:
2010:
2009:
1996:
1994:
1985:
1974:
1973:
1971:
1970:
1965:
1964:
1963:
1958:
1953:
1948:
1943:
1938:
1933:
1928:
1927:
1926:
1914:Cardiomyopathy
1911:
1910:
1909:
1907:Chagas disease
1898:
1896:
1890:
1889:
1887:
1886:
1885:
1884:
1879:
1869:
1868:
1867:
1858:
1847:
1845:
1836:
1832:
1831:
1828:
1827:
1825:
1824:
1823:
1822:
1817:
1807:
1806:
1805:
1795:
1794:
1793:
1788:
1777:
1775:
1769:
1768:
1766:
1765:
1764:
1763:
1758:
1748:
1747:
1746:
1741:
1730:
1728:
1724:
1723:
1721:
1720:
1715:
1710:
1705:
1699:
1694:
1687:
1685:
1678:
1672:
1671:
1663:
1662:
1655:
1648:
1640:
1631:
1630:
1627:
1626:
1615:
1603:
1602:
1600:
1596:
1595:
1592:
1591:
1576:
1560:
1555:
1554:
1552:
1551:Classification
1544:
1543:External links
1541:
1540:
1539:
1533:
1516:
1513:
1510:
1509:
1482:(13): 1921–3.
1466:
1425:
1404:(13): 2012–6.
1384:
1349:
1322:(2): 143–144.
1306:
1254:
1229:(23): 2012–3.
1209:
1165:
1126:
1077:
1058:(4): 350–352.
1040:
1013:(4): 210–212.
997:
991:978-1842145432
990:
967:
924:
917:
899:
878:(12): 2144–8.
855:
814:
776:
727:
684:
665:(25): 2410–6.
636:
617:
616:
614:
611:
579:
576:
533:
532:
529:
526:
516:
515:
512:
509:
506:
503:
492:
486:
480:
479:subacute onset
471:
468:
464:echocardiogram
453:enlarged heart
430:
429:
426:
419:
416:
334:
331:
330:
329:
326:
321:
316:
309:
298:
295:
258:
255:
188:
187:
180:
178:
97:
95:
88:
82:
79:
58:
57:
44:
38:
37:
33:
32:
24:
23:
15:
9:
6:
4:
3:
2:
2768:
2757:
2754:
2752:
2749:
2747:
2744:
2742:
2739:
2738:
2736:
2721:
2718:
2716:
2713:
2709:
2706:
2704:
2701:
2700:
2699:
2698:Heart failure
2696:
2694:
2691:
2690:
2688:
2684:
2678:
2675:
2671:
2668:
2666:
2663:
2662:
2661:
2658:
2654:
2651:
2649:
2646:
2644:
2641:
2640:
2639:
2636:
2635:
2633:
2631:
2627:
2617:
2614:
2610:
2609:ST depression
2607:
2605:
2602:
2600:
2597:
2596:
2595:
2594:
2590:
2586:
2583:
2582:
2581:
2580:
2576:
2572:
2569:
2568:
2567:
2566:
2562:
2558:
2555:
2553:
2550:
2549:
2548:
2547:
2543:
2542:
2540:
2536:
2530:
2527:
2525:
2522:
2520:
2517:
2515:
2512:
2511:
2509:
2507:
2503:
2497:
2494:
2492:
2489:
2487:
2484:
2483:
2481:
2479:
2475:
2469:
2466:
2464:
2461:
2459:
2456:
2454:
2451:
2449:
2445:
2442:
2441:
2439:
2437:
2433:
2427:
2424:
2420:
2417:
2416:
2415:
2412:
2410:
2407:
2405:
2402:
2401:
2399:
2397:
2392:
2386:
2383:
2381:
2378:
2377:
2375:
2373:
2369:
2363:
2360:
2358:
2355:
2353:
2350:
2349:
2347:
2343:
2333:
2330:
2328:
2325:
2323:
2320:
2319:
2317:
2315:
2311:
2303:
2300:
2298:
2295:
2294:
2293:
2290:
2286:
2283:
2282:
2281:
2278:
2277:
2275:
2273:
2269:
2266:
2263:
2259:
2254:
2250:
2244:
2241:
2237:
2236:Trifascicular
2234:
2232:
2229:
2227:
2224:
2222:
2219:
2217:
2214:
2212:
2209:
2208:
2207:
2204:
2202:
2199:
2195:
2192:
2190:
2187:
2185:
2182:
2181:
2180:
2177:
2175:
2171:
2168:
2166:
2163:
2161:
2158:
2157:
2155:
2153:
2149:
2146:
2144:
2139:
2135:
2119:
2118:regurgitation
2116:
2114:
2111:
2110:
2109:
2108:
2104:
2100:
2099:regurgitation
2097:
2095:
2092:
2091:
2090:
2089:
2085:
2081:
2080:regurgitation
2078:
2076:
2073:
2072:
2071:
2070:
2066:
2062:
2061:regurgitation
2059:
2057:
2054:
2052:
2049:
2048:
2047:
2046:
2042:
2041:
2039:
2035:
2027:
2024:
2022:
2019:
2018:
2017:
2016:
2012:
2008:
2005:
2004:
2003:
2002:
1998:
1997:
1995:
1993:
1989:
1986:
1984:
1979:
1975:
1969:
1966:
1962:
1959:
1957:
1954:
1952:
1949:
1947:
1944:
1942:
1939:
1937:
1934:
1932:
1929:
1925:
1922:
1921:
1920:
1917:
1916:
1915:
1912:
1908:
1905:
1904:
1903:
1900:
1899:
1897:
1895:
1891:
1883:
1880:
1878:
1875:
1874:
1873:
1870:
1866:
1862:
1859:
1857:
1854:
1853:
1852:
1849:
1848:
1846:
1844:
1840:
1837:
1833:
1821:
1818:
1816:
1813:
1812:
1811:
1808:
1804:
1801:
1800:
1799:
1796:
1792:
1789:
1787:
1784:
1783:
1782:
1779:
1778:
1776:
1774:
1770:
1762:
1759:
1757:
1754:
1753:
1752:
1749:
1745:
1744:Stable angina
1742:
1740:
1737:
1736:
1735:
1732:
1731:
1729:
1725:
1719:
1716:
1714:
1711:
1709:
1706:
1703:
1700:
1698:
1695:
1692:
1689:
1688:
1686:
1682:
1679:
1677:
1673:
1668:
1661:
1656:
1654:
1649:
1647:
1642:
1641:
1638:
1625:
1621:
1620:
1616:
1614:
1610:
1609:
1605:
1604:
1601:
1597:
1590:
1586:
1585:
1581:
1577:
1575:
1571:
1570:
1566:
1562:
1561:
1558:
1553:
1549:
1536:
1534:9789350906088
1530:
1526:
1525:
1519:
1518:
1505:
1501:
1497:
1493:
1489:
1485:
1481:
1477:
1470:
1462:
1458:
1453:
1448:
1444:
1440:
1436:
1429:
1421:
1417:
1412:
1407:
1403:
1399:
1395:
1388:
1380:
1376:
1372:
1368:
1365:(12): 916–7.
1364:
1360:
1353:
1345:
1341:
1337:
1333:
1329:
1325:
1321:
1317:
1310:
1302:
1298:
1294:
1290:
1285:
1280:
1276:
1272:
1268:
1261:
1259:
1244:
1240:
1236:
1232:
1228:
1224:
1220:
1213:
1205:
1201:
1196:
1191:
1188:(7): 587–10.
1187:
1183:
1179:
1172:
1170:
1161:
1157:
1153:
1149:
1146:(6): 1042–6.
1145:
1141:
1133:
1131:
1122:
1118:
1113:
1108:
1104:
1100:
1096:
1092:
1088:
1081:
1073:
1069:
1065:
1061:
1057:
1053:
1052:
1044:
1036:
1032:
1028:
1024:
1020:
1016:
1012:
1008:
1001:
993:
987:
983:
976:
974:
972:
963:
959:
955:
951:
947:
943:
939:
935:
928:
920:
914:
910:
903:
895:
891:
886:
881:
877:
873:
869:
862:
860:
851:
847:
842:
837:
834:(10): 832–6.
833:
829:
825:
818:
810:
806:
802:
798:
795:(9): 1150–3.
794:
790:
783:
781:
772:
768:
763:
758:
754:
750:
747:(6): 572–93.
746:
742:
738:
731:
723:
719:
715:
711:
707:
703:
700:(3): 308–17.
699:
695:
688:
680:
676:
672:
668:
664:
660:
653:
651:
649:
647:
645:
643:
641:
632:
628:
622:
618:
610:
608:
603:
601:
597:
593:
589:
585:
575:
572:
568:
566:
562:
558:
555:
550:
545:
541:
537:
530:
527:
524:
523:
522:
520:
513:
510:
507:
504:
501:
497:
493:
491:
487:
485:
481:
478:
477:
476:
467:
465:
460:
458:
454:
450:
445:
443:
438:
434:
427:
424:
420:
417:
414:
413:ST depression
410:
409:ST elevations
406:
405:
404:
402:
398:
394:
392:
388:
384:
380:
376:
372:
368:
364:
359:
357:
353:
349:
339:
327:
325:
322:
320:
317:
314:
310:
308:
304:
303:
302:
294:
292:
288:
284:
280:
276:
272:
268:
264:
254:
252:
248:
246:
242:
238:
234:
230:
225:
220:
218:
214:
210:
206:
202:
198:
194:
179:
175:
164:
161:
157:
154:
150:
147:
143:
140:
136:
133: –
132:
128:
127:Find sources:
122:
118:
112:
111:
107:
103:
98:This section
96:
87:
86:
78:
76:
72:
68:
65:is a type of
64:
54:
48:
45:
43:
39:
34:
30:
25:
20:
2630:Cardiomegaly
2604:ST elevation
2591:
2577:
2563:
2544:
2448:Ectopic beat
2396:fibrillation
2231:Bifascicular
2105:
2086:
2067:
2043:
2013:
1999:
1992:Endocarditis
1931:Hypertrophic
1865:Constrictive
1855:
1851:Pericarditis
1809:
1797:
1780:
1617:
1606:
1578:
1563:
1523:
1479:
1475:
1469:
1442:
1438:
1428:
1401:
1397:
1387:
1362:
1359:Am J Cardiol
1358:
1352:
1319:
1315:
1309:
1277:(19): e391.
1274:
1270:
1246:. Retrieved
1226:
1222:
1212:
1185:
1181:
1143:
1139:
1094:
1090:
1080:
1055:
1049:
1043:
1010:
1006:
1000:
981:
937:
933:
927:
908:
902:
875:
871:
831:
827:
817:
792:
788:
744:
740:
730:
697:
693:
687:
662:
658:
630:
621:
604:
600:Beck's triad
581:
569:
559:
543:
539:
534:
517:
511:acute trauma
484:leukocytosis
473:
461:
446:
439:
435:
431:
395:
360:
344:
307:pericarditis
300:
279:heart attack
260:
249:
221:
191:
172:October 2020
169:
159:
152:
145:
138:
126:
106:verification
99:
71:inflammation
67:pericarditis
62:
61:
2496:Romano–Ward
2463:Parasystole
2362:Ventricular
2314:Ventricular
2253:Tachycardia
2170:Heart block
2152:Bradycardia
1978:Endocardium
1941:Restrictive
1902:Myocarditis
1843:Pericardium
1608:MedlinePlus
1476:Circulation
1398:Circulation
1271:Circulation
1182:Eur Heart J
1097:(1): e122.
828:Eur Heart J
592:stethoscope
475:following:
313:hemodynamic
233:pericardium
100:needs more
75:pericardium
2735:Categories
2394:Flutter /
2357:Junctional
2292:Junctional
2285:Multifocal
2258:paroxysmal
2174:Sinoatrial
2143:arrhythmia
2138:Conduction
1894:Myocardium
1248:2015-12-22
1007:Cardiology
613:References
561:Colchicine
544:idiopathic
401:epicardium
315:compromise
193:Chest pain
142:newspapers
47:Cardiology
2653:Pulmonary
2436:Pacemaker
2107:pulmonary
2088:tricuspid
1924:Alcoholic
1619:eMedicine
1344:207381123
1293:0009-7322
1219:"Sign In"
962:208789653
578:Prognosis
549:ibuprofen
502:treatment
470:Treatment
333:Diagnosis
205:trapezius
42:Specialty
2519:Asystole
2419:Familial
2113:stenosis
2094:stenosis
2075:stenosis
2056:stenosis
2051:prolapse
1773:Sequelae
1676:Ischemia
1624:med/1781
1504:32460894
1496:16186432
1461:16186468
1420:16186437
1336:25539160
1301:24190942
1243:25404591
1204:15120056
1160:15028364
1121:24626086
1072:22516141
1027:22890314
954:15001332
894:14680742
850:10781355
809:12622586
771:20511488
722:25862792
714:22450720
679:25517707
447:A chest
440:Rarely,
375:troponin
281:such as
245:diastole
1919:Dilated
1861:Chronic
1669:(heart)
1379:8184826
1112:3951045
1035:5389517
762:2878263
554:aspirin
269:(e.g.,
263:unknown
241:systole
201:pleural
156:scholar
121:removed
2599:J wave
2352:Atrial
2280:Atrial
2069:aortic
2045:mitral
2037:Valves
1983:valves
1835:Layers
1704:(SCAD)
1613:000182
1531:
1502:
1494:
1459:
1418:
1377:
1342:
1334:
1299:
1291:
1241:
1202:
1158:
1119:
1109:
1070:
1033:
1025:
988:
960:
952:
934:Lancet
915:
892:
848:
807:
769:
759:
720:
712:
677:
594:, and
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